JTCS Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Massimo Caputo
Kelvin Lim
Masami Ochi
Gianni D. Angelini
Right arrow Permission Requests
Google Scholar
Right arrow Articles by Imura, H.
Right arrow Articles by Angelini, G. D.
PubMed
Right arrow Articles by Imura, H.
Right arrow Articles by Angelini, G. D.
Related Collections
Right arrow Extracorporeal circulation
Right arrow Mechanical Circulatory Assistance

J Thorac Cardiovasc Surg 2009;137:1530-1537
© 2009 The American Association for Thoracic Surgery

Cardiopulmonary Support

Pulmonary injury after cardiopulmonary bypass: Beneficial effects of low-frequency mechanical ventilation

Hajime Imura, MDa,*, Massimo Caputo, MDb, Kelvin Lim, FRCSb, Masami Ochi, MDa, M.-Saadeh Suleiman, DScb, Kazuo Shimizu, MDa, Gianni D. Angelini, FRCSb

a Department of Surgery, Division of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
b Bristol Heart Institute, Bristol University, Bristol, United Kingdom

Received for publication July 31, 2008; revisions received October 22, 2008; accepted for publication November 7, 2008.

* Address for reprints: Hajime Imura, MD, Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603, Japan. (Email: himura{at}nms.ac.jp).

Objective: Pulmonary dysfunction is a frequent postoperative complication after cardiac surgery with cardiopulmonary bypass, and atelectasis is thought to be one of the main causes. The aim of this study was to evaluate whether low-frequency ventilation and continuous positive airway pressure during cardiopulmonary bypass reduce postcardiopulmonary bypass lung injury.

Methods: Eighteen Yorkshire pigs were subjected to 120 minutes of cardiopulmonary bypass (1 hour of cardioplegic arrest) followed by 90 minutes of recovery before being sacrificed. Six animals served as control with the endotracheal tube open to atmosphere during cardiopulmonary bypass. The remaining animals were divided into 2 groups of 6: One group received continuous positive airway pressure of 5 cm H2O, and one group received low-frequency ventilation (5/minutes) during cardiopulmonary bypass. Lung tissue biopsy and bronchoalveolar lavage samples were obtained before and 90 minutes after discontinuation of cardiopulmonary bypass for measurement of adenine nucleotide (adenosine-5'-triphosphate, adenosine diphosphate, adenosine monophosphate), lactate dehydrogenase, DNA levels, and histology. Hemodynamic data and arterial blood gases were also collected through the study.

Results: The hemodynamic parameters were similar in the 3 groups. After cardiopulmonary bypass, the low-frequency ventilation group showed significantly better oxygen tension and alveolar arterial oxygen gradient, higher adenine nucleotide, lower lactate dehydrogenase levels, and reduced histologic damage in lung biopsy, as well as lower DNA levels in bronchoalveolar lavage compared with the control group. The continuous positive airway pressure group showed only significantly reduced lactate dehydrogenase levels compared with control.

Conclusion: Low-frequency ventilation during cardiopulmonary bypass in a pig experimental model reduces tissue metabolic and histologic damage in the lungs and is associated with improved postoperative gas exchange.

Abbreviations and Acronyms A-aDO 2 = alveolar arterial oxygen gradient; ADP = adenosine diphosphate; AMP = adenosine monophosphate; ATP = adenosine-5'-triphosphate; BAL = bronchoalveolar lavage; CABG = coronary artery bypass grafting; CPAP = continuous positive airway pressure; CPB = cardiopulmonary bypass; LFV = low-frequency ventilation; PaCO 2 = arterial carbon dioxide tension; PaO 2 = arterial oxygen tension; PCO 2 = carbon dioxide tension; PO 2 = oxygen tension






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2009 by The American Association for Thoracic Surgery.